Article

Mortality after surgery in Europe: a 7 day cohort study

Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
The Lancet (Impact Factor: 39.21). 09/2012; 380(9847):1059-1065. DOI: 10.1016/S0140-6736(12)61148-9

ABSTRACT The Lancet, 380 (2012) 1059-1065. doi:10.1016/S0140-6736(12)61148-9

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    ABSTRACT: Background Patient satisfaction is an important metric of health-care quality. Accidental awareness under general anaesthesia (AAGA) is a serious complication of anaesthesia care which may go unrecognised in the immediate perioperative period but leads to long-term psychological harm for affected patients. The SNAP-1 study aimed to measure patient satisfaction with anaesthesia care and the incidence of AAGA, reported on direct questioning within 24 h of surgery, in a large multicentre cohort. A secondary aim of SNAP-1 was to test the effectiveness of a new network of Quality Audit and Research Coordinators in NHS anaesthetic departments, to achieve widespread study participation and high patient recruitment rates. This manuscript describes the study methodology. Methods SNAP-1 was a prospective observational cohort study. The study protocol was approved by the National Research Ethics Service. All UK NHS hospitals with anaesthetic departments were invited to participate. Adult patients undergoing any type of non-obstetric surgery were recruited in participating hospitals on 13th and 14th May 2014. Demographic data were collected by anaesthetists providing perioperative care. Patients were then approached within 24 h of surgery to complete two questionnaires—the Bauer patient satisfaction questionnaire (to measure patient reported outcome) and the modified Brice questionnaire (to detect possible accidental awareness). Completion of postoperative questionnaires was taken as evidence of implied consent. Results were recorded on a standard patient case report form, and local investigators entered anonymised data into an electronic database for later analysis by the core research team. Results Preliminary analyses indicate that over 15,000 patients were recruited across the UK, making SNAP-1 the largest NIHR portfolio-adopted study in anaesthesia to date. Both descriptive and analytic epidemiological analyses will be used to answer specific questions about the patient perception of anaesthesia care overall and in surgical sub-specialties and to determine the incidence of AAGA. Conclusions The SNAP-1 study recruited a large number of UK hospitals and thousands of perioperative patients using newly established networks in the UK anaesthetic profession. The results will provide benchmarking information to aid interpretation of patient satisfaction data and also determine the incidence of AAGA reported on a single postoperative visit. Electronic supplementary material The online version of this article (doi:10.1186/s13741-015-0011-2) contains supplementary material, which is available to authorized users.
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    ABSTRACT: Central venous saturation (ScvO2) monitoring has been suggested to address the issue of adequate cardiocirculatory function in the context of cardiac surgery. Aim of this study was to determine the impact of low (<60%), normal (60-80%) and high (>80%) ScvO2 measured on ICU admission after cardiac surgery. Retrospective, cross-sectional, observational study at three intensive care units of a university hospital department for anaesthesiology and intensive care. Electronic patient records of all adults that underwent cardiac surgery between 2006 and 2013 and available admission measurements of ScvO2 were examined. Patients were allocated to one of three groups according to first ScvO2 measurement after ICU admission (group L <60%, group N 60-80%, group H >80%). Primary end-points were in-hospital and three-year follow-up survival. Data from 4,447 patients was included in analysis. Low and high initial measurements of ScvO2 were associated with increased in-hospital mortality (L: 5.6%, N: 3.3%, H: 6.8%), three-year follow-up mortality (L: 21.6%, N: 19.3%, H: 25.8%), incidence of post-operative haemodialysis (L: 11.5%, N: 7.8%, H: 15.3%) and prolonged hospital length of stay (L: 13d [9;22], N: 12d [9;19], H: 14d [9;21]). Adjusting for possible confounding variables, an initial ScvO2 above 80% was associated with an adjusted hazard ratio of 2.79 (95% CI: 1.565-4.964, p < 0.001) for in-hospital survival and 1.31 (95% CI: 1.033-1.672, p = 0.026) for three-year follow-up survival. Patients with high ScvO2 were particularly affected by unfavourable outcomes. Advanced haemodynamic monitoring may help to identify patients with high ScvO2 that developed extraction dysfunction to establish treatment algorithms in these patients to improve patient outcome.
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